SRP Behavioral Hospital of Fort Worth LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

100246 Issued in TX

Legal business name

SRP BEHAVIORAL HOSPITAL OF FORT WORTH LLC

Doing business as

WellBridge Healthcare of Fort Worth

Practice address

6200 Overton Ridge Blvd
Fort Worth, TX 76132-0000

Phone

(817) 361-1991

Fax

(817) 361-1993

NPI assigned

Jan 17, 2014

Last updated

Apr 8, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Barbara Shouse

Title

Delegated/Authorized Official

Phone

(502) 680-2115

Specialties & licenses 1

Addresses

Other names 1

• WellBridge Healthcare of Fort Worth Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Kent Autry, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dallas, TX
  • NPI 1326323353
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586304000000",
    "number": "1447672910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8343 DOUGLAS AVE STE 350",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752255887",
            "telephone_number": "817-361-1991",
            "fax_number": "817-361-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761320000",
            "telephone_number": "817-361-1991",
            "fax_number": "817-361-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRP BEHAVIORAL HOSPITAL OF FORT WORTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-17",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "SHOUSE",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "DELEGATED/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "502-680-2115"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "TX",
            "license": "100246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellBridge Healthcare of Fort Worth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bhavana Sreepad, MD
• Karthik Ram Srinivasan, MD
• Lavanya Srinivasan, M.D.
• Paulome Srivastava
• Nabieh Srouji, EMT
• SSC Fort Worth Nursing & Rehabilitation Center Operating Company LLC (Arlington Heights Health and Rehabilitation Center)
• Marygorreth Samanya Ssentamu
• SSQ Home Health Care,Inc
• St Dymphna Global Psychotherapy (Brannon LaForce LPC-S & Associates)
• Carlene Areta St John, FNP-BC

• Psychiatric Hospital in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychiatric Hospital in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.